Understanding Heart Attack: Diagnosis and Treatment

How Is a Heart Attack Diagnosed?

If your doctor suspects you are having a heart attack, he or she will promptly run tests, which may include:

ECG or EKG. The electrocardiogram is a simple test that records the electrical activity of the heart. The test can often accurately detect heart irregularities and help pinpoint the area of the heart attack. It could determine if someone is having a heart attack based on changes on the ekg, which show muscle damage or lack of blood flow through the arteries.

Blood tests. Several blood tests, often taken every 4 to 8 hours, can help diagnose a heart attack and detect any ongoing heart damage. 

Often, treatment for heart attack is started at this time. The doctor may recommend a test to pinpoint the location of the blocked artery -- and if it is possible, perhaps unblock it. These procedures may include:

Cardiac catheterization. In this procedure, a catheter (thin, hollow tube) is inserted into a blood vessel in the groin or wrist and threaded up to the heart. Dye is used to highlight the heart's arteries. Blockages can be identified and often treated with angioplasty or stents to open the artery and restore blood flow.  Several tests may be performed to assess the heart. Intravenous blood thinner is an option to open the artery, if cardiac catheterization is not available. 

Echocardiogram. In this ultrasound test, sound waves are bounced off the heart to create images. This test can identify significant damage to the heart muscle from the heart attack and identify the presence of heart failure. It can also determine is there is any damage to the heart valves.

Stress testing . Either a treadmill test or a radionuclide scan can assess whether other areas of the heart are still at risk for another heart attack.

What Are the Treatments for Heart Attack?

Emergency Medical Care for a Heart Attack

A heart attack is a medical emergency that requires immediate care to prevent permanent heart damage or death. CPR (cardiopulmonary resuscitation) should be started if the victim goes into cardiac arrest, when the heartbeat has stopped and the person is unresponsive. CPR doesn't restart the heart; it just keeps the victim alive until medical help arrives.

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An easy-to-use device called an AED (automated external defibrillator) is now available in many public places and can be used by almost anyone to treat cardiac arrest. This device works by shocking the heart back into a normal rhythm.

Treatment often begins in the ambulance if you called 911, or in the emergency room if someone else took you to the hospital. The first treatment given to a person suspected of having a heart attack is an aspirin. If you have called emergency services and are waiting for them to arrive, chew an aspirin (325 mg). Aspirin is a potent inhibitor of blood clots and can decrease the risk of death from the heart attack by 25%.

Heart Attack Treatment in the Hospital

At the emergency facility or hospital, a heart attack victim is rapidly given other drugs to prevent further blood clotting in the heart and decrease the strain on the heart. Treatment may also include a procedure to open up the blocked arteries.

  • Clot-busting drugs. These are given in the ER to open up blocked arteries. These powerful drugs are used if it will take too long to get a victim to the catheterization lab and to perform angioplasty and stenting.
  • Balloon angioplasty. This treatment can be performed, if needed, during a cardiac catheterization. A balloon-tipped catheter (thin, hollow tube) is inserted into the blocked artery in the heart. The balloon is inflated gently to press plaque outward against the walls of the artery, to open up the artery and improve blood flow. Most of the time this is not done without putting in a stent.
  • Stent placement. In this procedure, a small tube is inserted through a catheter into a blocked artery to "prop" it open. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time. Some stents have medicine that helps keep the artery from getting blocked again. The stenting procedure is often performed along with balloon angioplasty to help keep the artery open.
  • Bypass surgery. This surgical procedure allows a surgeon to re-route blood flow around a blocked artery to re-establish blood flow to part of the heart. A blood vessel from the person's leg or chest is usually used to bypass the blocked artery. Bypass surgery is typically done later, not as part of the emergency care of a heart attack. One, two, or more arteries can be bypassed.

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In the Coronary Care Unit (CCU)

Heart attack patients are usually hospitalized in coronary care units (CCU) for at least 36 hours. Once past the critical phase, patients continue to receive a variety of drugs, including:

  • Beta-blockers to slow the heart
  • Nitrates to increase heart blood flow
  • Blood thinners such as aspirin, Brilinta, clopidogrel, Effient, heparin, or Plavix to prevent further clotting
  • ACE inhibitors to help the heart muscle heal
  • Statins -- cholesterol-lowering drugs such as atorvastatin and simvastatin -- are now given routinely to help the heart muscle heal and lower the risk of another heart attack.
  • A “baby” aspirin - 81 mg daily

While hospitalized, a patient has his or her heart constantly monitored by ECG (electrocardiogram), in case abnormal heart rhythms develop. If the heart starts beating too fast or too slow, various medications may be given. Some patients may need to be fitted with a pacemaker, a battery-powered device to help maintain a steady heart rhythm. If a patient experiences a dangerous arrhythmia known as ventricular fibrillation, an electric shock to the chest is administered. Patients who show signs of heart failure are given a variety of medications to decrease strain on the heart and to encourage the heart to beat more forcefully.

People recovering from a heart attack are urged to get back on their feet as quickly as possible, which reduces the chances of blood clots forming in the deep veins of the legs, called a deep vein thrombosis, or DVT. These clots could travel through the circulatory system and lodge in the lung, creating a blockage. Gentle exercise is recommended, but nothing that requires significant exertion. Exercise after a heart attack, such as cardiac rehabilitation, can help improve and strengthen the heart muscle.

Some patients require further invasive procedures to improve blood flow to the heart. The two most common procedures are angioplasty -- a catheter technique that widens clogged arteries by breaking up plaques -- and coronary bypass surgery, which diverts blood flow around clogged arteries.

What Is the Outlook After a Heart Attack?

Long-term recovery from heart attack requires psychological and lifestyle adjustments: Quitting smoking is very important. Most heart attack survivors take a daily aspirin tablet to thin the blood and help prevent future heart attacks. Other drugs may also be prescribed, depending on the person’s condition.

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Exercise After Heart Attack

Regular, aerobic exercise greatly enhances efforts to recover from a heart attack -- and prevent a future heart attack. If you already have a heart condition, discuss a stress test with your doctor before beginning an exercise program to determine how much exertion is safe. Heart attack survivors are advised to exercise with other people rather than alone during the first months of recovery. Many hospitals and community health and recreation centers offer doctor-supervised cardiac rehabilitation programs, which can teach you about safe exercise and how to reach your target heart rate. It is important that during exercise after a heart event, your heart is monitored to ensure that there are no irregular or dangerous heart rhythms and to help evaluate the heart rate.

Mind/Body Medicine

Stress may be one of the risk factors you can control to help prevent heart attack and aid in recovery. Many techniques -- such as meditation, biofeedback, and yoga -- work by training the mind and body to relax. Relaxation has also been shown to provide relief from pain, which may be encountered during the recovery period.

Attitude is another consideration in heart attack recovery. People with a positive attitude about recovery tend to do much better. You may find that a particular mind-body technique helps you to focus on positive thoughts. You may also find, as many others have, that sharing thoughts and emotions with a support group is extremely beneficial.

Nutrition and Diet

The basic goals of a heart-healthy diet are to keep salt, sugar, and trans fats to a minimum. Minimize saturated fats, incorporate healthy fats filled with omega 3 fatty acids, eat multi-grains and vegetables to reduce cholesterol, control blood pressure, and control weight. Eating healthy foods like nuts, beans, bran, fish, and dark-green vegetables may help prevent future heart attacks.

Much evidence shows that unstable chemical compounds known as free radicals make the body more vulnerable to heart attack by promoting atherosclerosis in the coronary arteries. Free radicals may be neutralized by antioxidants such as vitamins A, C, and E, which are present in fruits, vegetables, and grains. However, taking these nutrients in supplement form has not been shown to improve heart health and are not recommended.

 

WebMD Medical Reference Reviewed by Suzanne R. Steinbaum, MD on June 22, 2016

Sources

SOURCES: 

News release, FDA.  

Heartcenteronline.com

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